Basic Information
| Provider Information | |||||||||
| NPI: | 1942649694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHMOUD | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | NAGIB | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6847 N CHESTNUT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442663929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302976110 | ||||||||
| FaxNumber: | 3302960592 | ||||||||
| Practice Location | |||||||||
| Address1: | 6847 N CHESTNUT ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | RAVENNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442663929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302976110 | ||||||||
| FaxNumber: | 3302960592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | TRN19226 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 35.139070 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.